oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-3-86-91oncotomsk-545Research ArticleОБЗОРЫREVIEWSРОЛЬ МРТ В КОМПЛЕКСНОЙ ЛУЧЕВОЙ ДИАГНОСТИКЕ НАРУШЕНИЙ ПРОХОДИМОСТИ МОЧЕТОЧНИКОВ У ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ (ОБЗОР ЛИТЕРАТУРЫ)ROLE OF MRI IN THE DIAGNOSIS OF URETERAL OBSTRUCTION IN CANCER PATIENTS (LITERATURE REVIEW)СураеваЮ. Э.SuraevaY. E.

аспирант

115634 г. Москва, Каширское шоссе, 24

Postgraduate

24, Kashirskoye shosse, 115478-Moscow

maicky@rambler.ruФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, г. МоскваРоссияN.N. Blokhin Russian Cancer Research Center, Ministry of Health of the Russian Federation, MoscowRussian Federation2017230720171638691Copyright © Сураева Ю.Э., 20172017Сураева Ю.Э.Suraeva Y.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/545

Причины осложнений с нарушением оттока мочи у онкологических пациентов являются важным аспектом в определении стратегии и тактики лечения. При выявлении данной патологии особую роль играют уровень и причины стеноза мочеточников. Несмотря на высокую информативность экскреторной урографии и компьютерной томографии в определении уровня стеноза мочеточников, их значимость и возможности в выявлении причин нарушения уродинамики именно в онкологии сравнительно невелики и фактически ограничены определением наличия или отсутствия конкрементов. В качестве альтернативы рассматривается магнитно-резонансная томография, которая благодаря высокой тканевой специфичности способна выявить не только уровень стеноза, но и его причину. Особенно важным представляется безопасность метода даже при необходимости использования контрастного усиления и отсутствие ионизирующего излучения. Комплексный и точный алгоритм обследования данной категории пациентов при использовании МРТ значительно уменьшает необходимый для точной диагностики объем процедур, включая инвазивные, и сокращает время диагностического этапа, позволяя быстрее перейти непосредственно к устранению причин дилатации мочеточников и сохранению функции почек. 

Complications related to the impairment of the urinary flow along the urinary tract in cancer patients are the important aspect in determining the treatment strategies for these patients. The level of ureteral obstruction is an especially important factor in diagnosis of this pathology. The excretory urography and computed tomography are effective tools in determining the level of ureteral obstruction, but their capabilities in identifying the causes of urodynamic disturbances in cancer patients are limited by the evaluation of the presence/absence of concrements. The magnetic resonance imaging (MRI) is considered as the safe alternative method. It is characterized by high tissue specificity and is able to detect not only the level of ureteral obstruction, but also the cause of its occurrence. It is especially important to note that even using contrast enhancement, MRI is a safe diagnostic tool, emitting no ionizing radiation. The MRI-based accurate diagnostic algorithm for this cohort of patients decreases the number of diagnostic procedures, especially the invasive ones. It provides opportunity to start etiological treatment earlier, thus safeguarding a kidney function. 

расширение мочеточниканарушение мочевыведенияэкскреторная урографиякомпьютерная томографиямагнитно-резонансная томографияМР-урографияureteral proliferationexcretory urographycomputed tomographymagnetic resonance imagingMR-urographyReferencesChristopher J.H., Nadir I.O., Christopher R. Current trends in urethral stricture management. Asian J Urol. 2014; 1 (1): 46–54.Christopher J.H., Nadir I.O., Christopher R. Current trends in urethral stricture management. Asian J Urol. 2014; 1 (1): 46–54.Browne C., Davis N.F., Mac Craith E., Lennon G.M., Mulvin D.W., Quinlan D.M., Mc Vey G.P., Galvin D.J. A narrative review on the pathophysiology and management for radiation cystitis. Adv Urol. 2015; 2015: 346812. doi: 10.1155/2015/346812.Browne C., Davis N.F., Mac Craith E., Lennon G.M., Mulvin D.W., Quinlan D.M., Mc Vey G.P., Galvin D.J. A narrative review on the pathophysiology and management for radiation cystitis. Adv Urol. 2015; 2015: 346812. doi: 10.1155/2015/346812.Borghese M., Corigliano N., Gabriele R., Antoniozzi A., Izzo L., Barbaro M., Caporale A. Benign schwannoma of the pelvic retroperitoneum. Report of a case and review of the literature. G Chir. 2000 May; 21 (5): 232–8.Borghese M., Corigliano N., Gabriele R., Antoniozzi A., Izzo L., Barbaro M., Caporale A. Benign schwannoma of the pelvic retroperitoneum. Report of a case and review of the literature. G Chir. 2000 May; 21 (5): 232–8.Faba O.R., Gaya J.M., Breda A., Del Dago P.J., Pisano F., Salas D., Palou J. Resection of the Intramural Portion of the Distal Ureter During Transurethral Resection of Bladder Tumors: Predictive Factors for Secondary Stenosis and Development of Upper Urinary Tract Recurrence. J Urol. 2016; 196 (1): 52–56. doi: 10.1016/j.juro.2016.01.038.Faba O.R., Gaya J.M., Breda A., Del Dago P.J., Pisano F., Salas D., Palou J. Resection of the Intramural Portion of the Distal Ureter During Transurethral Resection of Bladder Tumors: Predictive Factors for Secondary Stenosis and Development of Upper Urinary Tract Recurrence. J Urol. 2016; 196 (1): 52–56. doi: 10.1016/j.juro.2016.01.038.Deng F., Liu X., Li Y., Zhou Y., Tang J., Tang Y., Dai Y. Ureteral obstruction by prostate cancer leads to spontaneous ureteric rupture: a case report. Int J Clin Exp Med. 2015; 8 (9): 16842–16844.Deng F., Liu X., Li Y., Zhou Y., Tang J., Tang Y., Dai Y. Ureteral obstruction by prostate cancer leads to spontaneous ureteric rupture: a case report. Int J Clin Exp Med. 2015; 8 (9): 16842–16844.Смирнов Ю.А., Богачева Т.М., Валеев Р.Г. Ультразвуковая диагностика в оценке местной диагностики рака шейки матки. Казанский медицинский журнал. 2012; 93 (5): 735–738.Smirnov Yu.A., Bogacheva T.M., Valeev R.G. Ultrasound diagnosis in assessing the local diagnosis of cervical cancer. Kazan Medical Journal. 2012; 93 (5): 735–738. [in Russian]Кормош Н.Г., Лактионов К.П. Хирургическая стратегия при рецидивах рака яичников. Онкогинекология. 2014; 2: 17–26.Kormosh N.G., Laktionov K.P. Surgical strategy for recurrence of ovarian cancer. Oncogynecology. 2014, 2: 17–26. [in Russian]Давыдов М.И. Статистика злокачественных новообразований в России и странах СНГ в 2005 г. Вестник РОНЦ им. Блохина. 2006; 17 (3): 202.Davydov M.I. Statistics of malignant neoplasms in Russia and CIS countries in 2005. Bulletin of the Blokhin Cancer Research Center. 2006; 17 (3). Suppl. 1: 202. [in Russian]Бойко В.В., Криворотько И.В. 10-летний опыт применения комбинированных операций при местнораспространенном раке прямой кишки. Международный медицинский журнал. 2009; 1: 50–57.Boiko V.V., Krivorot’ko I.V. 10-year experience of combined operations with locally advanced rectal cancer. International Medical Journal. 2009; 1: 50–57. [in Russian]Moosavi B., Fasih N., Virmani V., Kielar A. Beyond ureterolithiasis: gamut of abnormalities affecting the ureter. Clin Imaging. 2016; 40 (4): 678–690. doi: 10.1016/j.clinimag.2016.01.003.Moosavi B., Fasih N., Virmani V., Kielar A. Beyond ureterolithiasis: gamut of abnormalities affecting the ureter. Clin Imaging. 2016; 40 (4): 678–690. doi: 10.1016/j.clinimag.2016.01.003.Song L., Xie M., Zhang Y., Xu Y. Imaging techniques for the diagnosis of male traumatic urethral strictures. J X-ray Sci Technol. 2013; 21 (1): 111–123. doi: 10.3233/XST-130358.Song L., Xie M., Zhang Y., Xu Y. Imaging techniques for the diagnosis of male traumatic urethral strictures. J X-ray Sci Technol. 2013; 21 (1): 111–123. doi: 10.3233/XST-130358.Papachristou F., Pavlaki A., Printza N. Urinary and serum biomarkers in ureteropelvic junction obstruction: a systematic review. Biomarkers. 2014; 19 (7): 531–40. doi: 10.3109/1354750X.2014.943292.Papachristou F., Pavlaki A., Printza N. Urinary and serum biomarkers in ureteropelvic junction obstruction: a systematic review. Biomarkers. 2014; 19 (7): 531–40. doi: 10.3109/1354750X.2014.943292.Стусь В.П., Моисеенко Н.Н., Дубовская Н.В. Отдаленные результаты лечения артифициальных повреждений мочеточника во время гинекологических и акушерских вмешательств. Украинский научно-практический журнал урологов, андрологов и нефрологов. 2014; 18 (2): 11–19.Stus’ V.P, Moiseenko N.N, Dubovskaya N.V. Long-term results of treatment of official ureteral lesions during gynecological and obstetric interventions. Ukrainian scientific and practical journal of urologists, andrologists and nephrologists, 2014; 18 (2): 11–19. [in Russian]Klaipetch A., Namwongprom S., Ekmahachai M., Lojanapiwat B. Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability? Singapore Med J. 2013; 54 (5): 267–270.Klaipetch A., Namwongprom S., Ekmahachai M., Lojanapiwat B. Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability? Singapore Med J. 2013; 54 (5): 267–270.Esmaeili M., Esmaeili M., Ghane F., Alamdaran A. Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children. Iran J Pediatr. 2016 Feb; 26 (1): e4293. doi: 10.5812/ijp.4293.Esmaeili M., Esmaeili M., Ghane F., Alamdaran A. Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children. Iran J Pediatr. 2016 Feb; 26 (1): e4293. doi: 10.5812/ijp.4293.Tzeng W.S., Wu R.H., Huang S.K.M., C.W., Liao A.C., Lin V.C. A comparison of pyelography and various reconstructions of multidetector helical computed tomography urography images for diagnosing urinary obstruction. Clin Imaging. 2012; 36 (6): 773–779. doi: 10.1016/j. clinimag.2011.11.015Tzeng W.S., Wu R.H., Huang S.K.M., C.W., Liao A.C., Lin V.C. A comparison of pyelography and various reconstructions of multidetector helical computed tomography urography images for diagnosing urinary obstruction. Clin Imaging. 2012; 36 (6): 773–779. doi: 10.1016/j. clinimag.2011.11.015Deng J., Lu X., Liu Y. Ectopic insertion of a duplicated ureter into prostatic urethra: Demonstration by 3D multi-detector computed tomography urography. Journal of X-ray science and technology. 2016; 24 (5): 661–664.Deng J., Lu X., Liu Y. Ectopic insertion of a duplicated ureter into prostatic urethra: Demonstration by 3D multi-detector computed tomography urography. Journal of X-ray science and technology. 2016; 24 (5): 661–664.Juri H., Tsuboyama T., Kumano S., Inada Y., Koyama M., Azuma H., Narumi Y. Detection of bladder cancer: comparison of low-dose scans with AIDR 3D and routine-dose scans with FBP on the excretory phase in CT urography. Br J Radiol. 2016; 89 (1058): 20150495. doi: 10.1259/ bjr.20150495.Juri H., Tsuboyama T., Kumano S., Inada Y., Koyama M., Azuma H., Narumi Y. Detection of bladder cancer: comparison of low-dose scans with AIDR 3D and routine-dose scans with FBP on the excretory phase in CT urography. Br J Radiol. 2016; 89 (1058): 20150495. doi: 10.1259/ bjr.20150495.Park J.J., Park B.K., Kim C.K. Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria. Eur Radiol. 2016; 26 (10): 3550–57. doi: 10.1007/s00330-016-4206-9.Park J.J., Park B.K., Kim C.K. Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria. Eur Radiol. 2016; 26 (10): 3550–57. doi: 10.1007/s00330-016-4206-9.Moloney F., Murphy K.P., Twomey M., O'Connor O.J., Maher M.M. Haematuria: An Imaging Guide. Adv Urol. 2014; 2014: 414125. doi: 10.1155/2014/414125.Moloney F., Murphy K.P., Twomey M., O'Connor O.J., Maher M.M. Haematuria: An Imaging Guide. Adv Urol. 2014; 2014: 414125. doi: 10.1155/2014/414125.Sudah M., Masarwah A., Kainulainen S., Pitkänen M., Matikka H., Dabravolskaite V., Aaltomaa S., Vanninen R. Comprehensive MR Urography Protocol: Equally Good Diagnostic Performance and Enhanced Visibility of the Upper Urinary Tract Compared to Triple-Phase CT Urography. Plos one 2016; 11 (7): e0158673.Sudah M., Masarwah A., Kainulainen S., Pitkänen M., Matikka H., Dabravolskaite V., Aaltomaa S., Vanninen R. Comprehensive MR Urography Protocol: Equally Good Diagnostic Performance and Enhanced Visibility of the Upper Urinary Tract Compared to Triple-Phase CT Urography. Plos one 2016; 11 (7): e0158673.Sharma A., Sodhi K.S., Saxena A.K., Bhatia A., Menon P., Rao K.L., Khandelwal N. Comparison of intravenous urography and magnetic resonance urography in preoperative evaluation of pelvi-ureteric junction obstruction in children. J Indian Assoc Pediatr Surg. 2016; 21 (4): 169–174.Sharma A., Sodhi K.S., Saxena A.K., Bhatia A., Menon P., Rao K.L., Khandelwal N. Comparison of intravenous urography and magnetic resonance urography in preoperative evaluation of pelvi-ureteric junction obstruction in children. J Indian Assoc Pediatr Surg. 2016; 21 (4): 169–174.Çifçi E., Çoban G., Çiçek T., Gönülalan U. The diagnostic value of magnetic resonance urography using a balanced turbo field echo sequence. Eur Radiol. 2016; 26 (12): 4624–4631.Çifçi E., Çoban G., Çiçek T., Gönülalan U. The diagnostic value of magnetic resonance urography using a balanced turbo field echo sequence. Eur Radiol. 2016; 26 (12): 4624–4631.Roy C., Ohana M., Host P., Alemann G., Labani A., Wattiez A., Lang H. MR urography (MRU) of non-dilated ureter with diuretic administration: Static fluid 2D FSE T2-weighted versus 3D gadolinium T1- weighted GE excretory MR. Eur J Radiol Open. 2014; 6 (1): 6–13. doi: 10.1016/j.ejro.2014.08.001.Roy C., Ohana M., Host P., Alemann G., Labani A., Wattiez A., Lang H. MR urography (MRU) of non-dilated ureter with diuretic administration: Static fluid 2D FSE T2-weighted versus 3D gadolinium T1- weighted GE excretory MR. Eur J Radiol Open. 2014; 6 (1): 6–13. doi: 10.1016/j.ejro.2014.08.001.Childs D.D., Leyendecker J.R., Gianini J., Hall C. Contrastenhanced magnetic resonance urography at 3T: clinical feasibility. J Comput Assist Tomogr. 2013; 37 (1): 29–36. doi: 10.1097/ RCT.0b013e3182711fd9Childs D.D., Leyendecker J.R., Gianini J., Hall C. Contrastenhanced magnetic resonance urography at 3T: clinical feasibility. J Comput Assist Tomogr. 2013; 37 (1): 29–36. doi: 10.1097/ RCT.0b013e3182711fd9Boss A., Martirosian P., Fuchs J., Obermayer F., Tsiflikas I., Schick F., Schäfer J.F. Dynamic MR urography in children with uropathic disease with a combined 2D and 3D acquisition protocol--comparison with MAG3 scintigraphy. Brit J Radiol. 2014; 87 (1044): 20140426. doi: 10.1259/bjr.20140426Boss A., Martirosian P., Fuchs J., Obermayer F., Tsiflikas I., Schick F., Schäfer J.F. Dynamic MR urography in children with uropathic disease with a combined 2D and 3D acquisition protocol--comparison with MAG3 scintigraphy. Brit J Radiol. 2014; 87 (1044): 20140426. doi: 10.1259/bjr.20140426Leyendecker J.R., Barnes C.E., Zagoria R.J. Urography: Techniques and Clinical Applications. Radiographics. 2008 Jan-Feb; 28 (1): 23–46. doi: 10.1148/rg.281075077.Leyendecker J.R., Barnes C.E., Zagoria R.J. Urography: Techniques and Clinical Applications. Radiographics. 2008 Jan-Feb; 28 (1): 23–46. doi: 10.1148/rg.281075077.Sudah M., Vanninen R., Partanen K., Heino A., Vainio P., AlaOpas M. MR urography in evaluation of acute flank pain: T2-weighted sequences and gadolinium-enhanced three-dimensional FLASH compared with urography. AJR Am J Roentgenol 2001; 176: 105–112.Sudah M., Vanninen R., Partanen K., Heino A., Vainio P., AlaOpas M. MR urography in evaluation of acute flank pain: T2-weighted sequences and gadolinium-enhanced three-dimensional FLASH compared with urography. AJR Am J Roentgenol 2001; 176: 105–112.Shokeir A.A., El-Diasty T., Eassa W., Mosbah A., Mohsen T., Mansour O., Dawaba M., El-Kappany H. Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography. Urology. 2004; 63: 225–229.Shokeir A.A., El-Diasty T., Eassa W., Mosbah A., Mohsen T., Mansour O., Dawaba M., El-Kappany H. Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography. Urology. 2004; 63: 225–229.

The authors declare that there are no conflicts of interest present.